This document outlines a behavior change communication (BCC) strategic framework for reducing leprosy in Simthali VDC, Kavre, Nepal. The goals are to decrease leprosy prevalence, increase awareness of transmission and treatment, and reduce stigma. The framework involves assessing the target population, developing messages to increase healthcare seeking and treatment compliance, and monitoring implementation. Key activities include using mass media, community events, and healthcare workers to disseminate messages promoting knowledge of leprosy and reducing stigma. The strategy will be pre-tested, implemented while monitoring progress, and evaluated to refine the approach as needed.

1. By:
Rama Khadka
BEHAVIOR CHANGE COMMUNICATION
FOR LEPROSY
A STRATEGIC FRAMEWORK
FOR SIMTHALI VDC, KAVRE

2. Introduction
Leprosy is a communicable disease. It is also known as
Hansen’s disease and this is the world’s oldest recorded
disease. 80 % of cases in 5 countries (India, Myanmar,
Indonesia, Brazil, Nigeria).

3. In the context of the Leprosy epidemic, BCC is an essential part
of a comprehensive program that includes different services like
medical, social, psychological and spiritual and commodities etc.

4. Before individuals and communities can reduce their level of
risk or change their behaviors, they must first understand
basic facts about the disease, adopt key attitudes, learn a set
of skills and be given access to appropriate products and
services.
They must also perceive their environment as supporting
behavior change and the maintenance of safe behaviors, as
well as supportive of seeking appropriate treatment for
prevention, care and support.

5. Goals
 To decrease the prevalence of the leprosy in the target
population.
 To aware the target population about the transmission and
proper treatment of the disease.
 To reduce the stigma associated with the disease.

6. Stakeholders
The stake holder includes:
 Policymakers
 opinion leaders
 community leaders
 Religious leaders
 Local health care provider
 Female community health volunteer
 Members of target populations including people with leprosy.

7. Target population
Primary target population
 People suffering from leprosy
 And their family who are in close contact
 Uninformed service provider

8. Secondary target population
 Local health care provider
 Religious leader
 Policymakers
 Social service worker
 Local communities and families.

9. BCC Assessment
 Risk situations, showing in detail how decisions are made in
different situations, including what influences the decisions
and settings for risk
 Why individuals and groups practice the behaviors they do, and
why they might be motivated to change (or unable to change)
to the desired behaviors including stigma
 Perceptions of risk and risk behaviors
 Influences on behavior, such as barriers or benefits

10.  Insights of opinion leaders
 Patterns of service use and opinions about these services
 How likely the individual seek for the available service
 Existing policies
 Media resources

11. Segment of target population
According to the demographic factor target population are
 People suffering from the Leprosy falls under the lower
class or backward communities and their families
 People with higher class and caste suffering from disease

12. According to psychosocial factor
 Religious leader
 Local clubs working on social issues
 Local leaders
 Health care provider

13. Behavior change objectives
 Reduce the stigma and discrimination associated with
leprosy
 Increase incidence of health care seeking behavior
 Improved compliance with drug treatment regimens
 Improved attitudes and behavior among healthcare, social
service and other service delivery workers who interact
with leprosy patients.

14.  Improve the sanitary condition in the marginalized group.
 Increased involvement of opinion leaders and
policymakers, private sector managers and community
members
 Increased involvement in self-help and homecare
initiatives

15. BCC strategy and Monitoring and Evaluation
plan
 BCC objective
 Reduce the stigma and discrimination associated with
leprosy (People will gain proper knowledge about the
disease)
 Increase incidence of health care seeking behavior (People
in risk and patients will seek for treatment)
 Improved compliance with drug treatment regimens
(Patients will complete the treatment)

16.  Improved attitudes and behavior among healthcare, social
service and other service delivery workers who interact with
leprosy patients. (Will be provided accurate knowledge about
mode of transmission and treatment)
 Improve the sanitary condition in the marginalized group. (
prevention steps are clearly taught to the group)
 Increased involvement of opinion leaders and policymakers,
private sector managers and community members (Correct
knowledge will be provided)
 Increased involvement in self-help and homecare initiatives

17. Theme and Message
 “Leprosy, like other disease it can be cured if treated
properly.”
 “Let’s end stigma and work together to fight leprosy.”

18.  Channels
a. Mass media
 Television
 Local radio station
 Posters
 Flip charts
 Articles
 Bulletin board

19. b. Persons
 By health workers
 Peer educators
 Counselors
 Other trained personnel.

20. c. Others
Additional means of delivery include;
 Musical or dramatic performances
 Community events
 “gimmicks” such as key chains or stickers, t-shirts
 Seminars
 Role-play
 Panel discussion
 Group discussion etc.

21.  Monitoring and evaluation
The following areas will be closely monitored
 Reach: Are adequate numbers of the audience being reached
over time?
 Coordination: Are messages adequately coordinated with
service and supply delivery and with other communication
activities?
 Schedule: Are communication activities taking place on
schedule, at the planned frequency?

22.  Scope: Is communication effectively integrated with the
necessary range of audiences, issues and services?
 Quality: What is the quality of communication (messages,
media and channels)?
 Feedback: Are the changing needs of target populations being
captured?

23. Periodic focus-group discussions and in-depth interviews will
be conducted to assess the perceptions of target
populations.
The above given areas will be closely monitored by different
modes and methods and the evaluation of the effectiveness
of BCC will be made and the further plans will be made
based on the evaluation.

24.  Partners
The key partners will be selected for the design and implementation
of the components of the BCC
 NGOs
 Government counterparts
 Media outlets
 Local newspaper
 Local clubs
 Graphic designer
 Local traditional entertainers
 Members of target populations
 Other program implementers

25. Communication Products
The communication products include:
 Print materials for peer educators, such as flip charts and
picture codes
 Print materials to support health workers on specific care
issues like IEC materials
 Television spots for general broadcast
 Promotional materials about the project, for advocacy

26.  Scripts for theater and street theater
 Radio or television soap opera scripts
 Radio jingle
 Printed t-shirts and bags for volunteers

27. Pre-testing
Pre-testing was conducted with the both primary and secondary
target population along with the compare group. The level of
knowledge, concept, attitude, views, ideas were pre-tested in
the following areas:
 Comprehension
 Attraction
 Persuasion
 Acceptability
 Audience members’ degree of identification etc.

28. Another VDC of the Kavre district “Chautara” was use as a
compare VDC for the pre-test through the in-depth interview
and focus group discussion etc. Data of the both community
from the pre-test was compared before the implementation
of the programme.

29. Implement and monitor
In this phase the BCC plan will be implemented in the intended
community. Following areas will be considered;
 Coordination between all partners, programmers and channels
of the BCC strategy.
 Links among critical program elements, such as supply and
demand.
 Timing of the strategy

30.  Active participation of the intended population
 Regular meetings between all the partners and
stakeholders
 If the intended channel is followed or not
 Budgeting

31. In all the steps mentioned above monitoring of the strategy will
be followed constantly.
Specific personnel must be designated to make sure that the
monitoring plan is developed with input from the people who
will use it.

32. Evaluate
 BCC interventions will be evaluated against the stated
objectives and in reference to a baseline data obtained
from the pre-test.
 Baseline quantitative research may be repeated to
demonstrate changes in knowledge, attitudes and
reported behaviors relative to communication and
project-level behavior change objectives if needed.

33.  Change can also be assessed through qualitative research
into target-group responses to interventions.
 Which involves examining data designed to illustrate
changes in audience behavior.

34. Elicit feedback and modify the program
As soon as the evaluation stage ends, it will be clear if the
target populations acquire new knowledge and behaviors, and
communication needs may change.
 The needs of target populations must be periodically
reassessed to understand where they stand along the behavior
change continuum.
 There might be a need of modifications of the overall
program, as well as of the BCC strategies, messages and
approaches.

35.  Day-to-day monitoring will provide information for making
adjustments in short-term work planning.
 Periodic program reviews can be designed to take a more
in-depth look at program progress and larger-scale
adjustments or redesign.

36.  Involving stakeholders, target audiences and partners as
much as possible will provide a better look at what is
happening; help make appropriate decisions; and make
sure that the people affected by any decisions will be
fully aware of them.
 So the proper evaluation of the programme will be
performed hand change in the strategy or the overall
programme will be made if necessary.